Check Campus attending:

University Drive, Corner Brook

Trades Division, Logy Bay Road, St. John's

Kenmount Road, St. John's

Personal Information:

*Last Name:

*First Name:

Initial:

Permanent Address:

Street / PO Box:

City / Town:

Province / State:

Other Province:

Country:

Postal / Zip Code:

*Telephone:

*Email Address:

Present Mailing Address (if different than above):

Street / PO Box:

City / Town:

Province / State:

Other Province:

Country:

Postal / Zip Code:

Telephone:

Date of Birth (dd/mm/yyyy):

/ / Male Female

MCP:

SIN:

Marital Status:

Single Married Other

Maiden Name:

Valid Driver's License?:

Yes No

If yes, Driver's License No.:

License Classification:

01 02 03 04 05 06
07 08 09

Enrollment Information:

I wish to start at Academy Canada at:

/ / (dd/mm/yyyy)

Program: 1st Choice:

Program: 2nd Choice:

To better serve students, upon acceptance into his/her program of choice, Academy Canada wishes to know of any disabilities (ie. learning disability, physical disability or other circumstances) that may affect program delivery.

Application Status:

1

New Student

2

Student from different college/school from previous year.
Indicate school

3

Returning student from another year other than previous year.

4

Have members of your family ever attended Academy Canada full-time?
If yes, how many?

Have you previously applied to or attended any campus of this college?

Yes No

If yes, indicate Academy Canada campus

Program Applied:

Year (yyyy):

Program Applied:

Year (yyyy):

Educational Information:

Are you a current high school student?

Yes

What year will you graduate?
(yyyy)
What school are you attending?

No

What grade did you complete?
Year? (yyyy)
School Attended

Please check if you have enrolled in and/or completed the following types of education or training programs:

VOCATIONAL

Enrolled Completed

School

Year completed (yyyy)

Program

City / Province

2-to-3-YEAR DIPLOMA

Enrolled Completed

School

Year completed (yyyy)

Program

City / Province

UNIVERSITY

Enrolled Completed

School

Year completed (yyyy)

Program

City / Province

ADULT UPGRADING

Enrolled Completed

School

Year completed (yyyy)

Program

City / Province

OTHER

Enrolled Completed

School

Year completed (yyyy)

Program

City / Province

(A copy of grades must accompany this application. If a copy cannot be forwarded at this time, please write a letter to the Admissions Officer explaining.)

Financial Information:

Please answer the following:

Yes
No

I wish to receive a student loan application
(Note: Student Loan Application Forms for September registration will not be available until May of that year.)

Yes
No

I have visited Academy Canada.

Yes
No

I wish to receive a boarding house/apartment list.

Yes
No

I have had an interview with Academy Canada personnel:
(If yes,with whom?)

What convinced you to apply to Academy Canada? (Please check one of the following):

Program/Curriculum

Relative/Friend. If yes, whom

School Representative. If yes, whom

School Staff. If yes, whom

Accreditation

Other (please specify)

Notice of Waiver:
Every effort is made to ensure the accuracy of this information as of the date of publication; however, information of this type tends to become outdated with time. The College, therefore, reserves the right to modify or cancel any program, option, course, objective, fee, timetable or campus location without notice or prejudice. The College also does not assume responsibility for changes made after publication or in areas beyond its control because, while course outlines are updated annually, textbooks, materials and information change with little or no notice. The College reserves the right to modify, change, add or delete topics without notice or prejudice.

I, the applicant, understand and agree to the abovementioned policies. I further agree that my acceptance to any program is subject to sufficient enrollment.